Testing the Pain Relief of musculOskeletal conditions and Arthritis using Carefully Tailored InterVEntions (PROACTIVE) Intervention: A Randomized Controlled Trial

Chronic musculoskeletal conditions and their primary source of pain, movement-evoked pain (MEP), causes
significant pain interference, long-term mobility impairment, healthcare costs, and psychosocial inequalities for
individuals, families, communities, and society-at-large. MEP affects more adults in later life and is perceived
as more severe than resting pain. Many older adults hesitate to use opioids and non-steroidal antiinflammatory
drugs long-term and rely on non-pharmacological pain self-management (SM) strategies. Current
studies of chronic musculoskeletal pain (CMP) SM interventions do not measure MEP as a primary endpoint
nor address faith/spirituality, varied traditions, and underlying potentially modifiable health indicators (e.g.,
health literacy, financial hardship), and therefore only offer small or no benefit over control conditions. We
propose to enhance older adults’ capacity to manage MEP by investigating the effects of a tailored pain SM
intervention (Pain Relief for musculOskeletal conditions and Arthritis using Carefully Tailored InterVEntions
[PROACTIVE]). This prototype intervention will provide focused pain SM education with a SM resource toolkit,
active prayer, and financial counseling to explain participants’ healthcare benefits for pain care. This
intervention moves beyond basic tailoring and targets multiple areas for behavior change that are of
importance to adults in later life. We have assembled an interdisciplinary and clinically experienced team to
lead this study. We will enroll 120 adults (age 50-92 years) with CMP into a parallel group, single-blind,
randomized controlled trial to test whether PROACTIVE decreases MEP (primary outcome) in the immediate
post-intervention period (n= 60) (Aim 1) and over time (Sub-Aim 1a) compared to a usual care control group
(n= 60). To determine efficacy, we will use state-of-the-art and real-time technologies to measure MEP as well
as pain interference, pain coping, and physical function (secondary outcomes) (Sub-Aim 1b). The PROACTIVE
group will work with a nurse and financial counselor over four weeks to enhance knowledge of CMP SM,
utilization of active prayer and faith, and financial literacy of health insurance benefits and resources available
to cover treatments for pain. Each weekly session will last up to 2 hours and will be followed by six days of
ecological momentary assessments of pain and SM outcomes and ecological momentary interventions guiding
participants through weekly SM skills. A fourth booster session will reinforce content and training and help
sustain SM. Also, we will examine the differential effects of PROACTIVE on MEP according to demographic
and psychosocial factors (Aim 2). The proposed intervention is expected to produce meaningful reductions in
MEP in aging adults experiencing disabling chronic musculoskeletal conditions. Ideally, this study will identify
precision behavior targets and responders to inform intervention refinement.

Grant Number: 5R01NR021183-02
NIH Institute/Center: NIH
Principal Investigator: Staja Booker